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The more athletes know, the better they can manage the risk of a positive test. Athletes should take the time to read through this short list highlighting just a few of the top 2018 World Anti-Doping Agency (WADA) Prohibited List changes and prohibited substances that impact athletes.
Updates to the 2018 WADA Prohibited List
In 2018, there are a number of changes that athletes need to be aware of, and two of the main changes are highlighted below.
1. Increase in Intravenous (IV) Infusion Limits
With the 2018 WADA Prohibited List, the allowed volume and timing of IV infusions of permitted substances will increase to no more than a total of 100 mL (~6.8 tablespoons) per 12-hour period. More specifically, IV infusions and/or injections of any substance in excess of 100 mL per 12-hour period are prohibited at all times, except for those legitimately received in the course of hospital treatment, surgical procedures, or clinical diagnostic investigations. For example, TUEs are still required for infusions provided through on-site event medical services, ambulatory treatment, outpatient clinics, IV or wellness boutiques, doctors’ or medical offices, home visits, and all other non-hospital locations.
**If a prohibited substance is administered intravenously or via injection, a TUE is necessary for this substance regardless of whether the infusion or injection is less than 100mL.
2. Cannabidiol Removed from the List
Starting in 2018, natural and synthetic cannabidiol (e.g., CBD oil) is no longer prohibited in-competition, but all other forms of cannabis remain prohibited in-competition, including marijuana, hashish, and all THC-containing products. Be aware, cannabidiol extracted from cannabis plants may still contain varying concentrations of prohibited THC, so athletes should continue to be cautious about using CBD products that may contain THC around the in-competition period.
Specific Substance Warnings
There are a number of substances and products that continue to be problematic for athletes because of product contamination and other issues, including those below.
1. SARMs – Prohibited Anabolic Agents
SARMs (selective androgen receptor modulators), such as andarine and ostarine, are prohibited under this category. The unfortunate reality is that some dietary supplement manufacturers illegally put SARMs in their products, and some omit these substances from the label entirely or use misleading names to confuse consumers. In 2018, LGD-4033 and RAD140 were added as further examples of SARMs.
There have been many instances of products marketed as dietary supplements that contain one or more anabolic agents. For examples, see the High Risk List on Supplement411.org, and remember that the use of any supplement is at an athlete’s own risk.
Clomiphene is prohibited at all times as an anti-estrogenic substance. A selective estrogen receptor modulator (SERM), clomiphene is used in female fertility brand name prescription medications, such as Clomid®. Even after a single oral dose of Clomid, clomiphene and clomiphene metabolites can remain in the urine for many weeks. All athletes are required to get a TUE in advance of using clomiphene.
Clomiphene is not FDA-approved for any clinical indication in men and TUEs are unlikely to be granted to men who receive off-label prescriptions for clomiphene.
With more than 1,700 reported clenbuterol positive tests over the past 10 years, athletes need to remain vigilant about possible unintentional clenbuterol ingestion when in Mexico and China. There is no urinary threshold reporting limit for clenbuterol, meaning the detection of any amount of clenbuterol in an athlete’s sample is a positive test.
As a growth promotor in livestock, clenbuterol can be ingested by eating cooked or uncooked meat outside the United States, so athletes should be very cautious to eat meat only from reputable sources, and should avoid consuming liver or liver-derived products outside the United States. Clenbuterol may also be found illegally in some weight loss dietary supplements.